Health Problem: Estimates suggest that 4 million Americans suffer from severe treatment-resistant depression (TRD) that is refractory to multiple therapies. TRD is typically defined as depression that does not respond to at least 2 attempts at treatment of adequate duration with appropriate doses of antidepressants, but there is no official consensus definition.

Technology Description: Intravenous injection (IV) of ketamine hydrochloride as an adjunct to electroconvulsive therapy (ECT) is intended to reduce symptoms of depression more rapidly and to a greater extent than ECT alone in patients who have TRD.

Controversy: Early evidence for the antidepressant effect of ketamine came from uncontrolled studies and TRD may have diverse causes and poor response rates that make it difficult to demonstrate whether or not ketamine treatment is effective.     

Key Questions:

  • Does ketamine as an adjunct to electroconvulsive therapy (ECT) augment or improve the effectiveness of ECT for treatment of patients with treatment-resistant depression (TRD)?
  • How does ketamine as an adjunct to ECT compare with other strategies for treating TRD?
  • Is ketamine as an adjunct to ECT safe for the treatment of TRD?
  • Have definitive patient selection criteria been established for the use of ketamine as an adjunct to ECT for TRD?

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